Healthcare Provider Details

I. General information

NPI: 1790359024
Provider Name (Legal Business Name): HIDEKI TSUNODA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2021
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

163 BUTNER DR
HOPE IN
47246-9447
US

IV. Provider business mailing address

11 TRAFALGAR SQ
TRAFALGAR IN
46181-9515
US

V. Phone/Fax

Practice location:
  • Phone: 812-546-6000
  • Fax: 812-546-0368
Mailing address:
  • Phone: 317-680-9103
  • Fax: 317-878-2355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01092799A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: